TB remains problem in Indonesia

http://www.thejakartapost.com/detailheadlines.asp?fileid=20070314.@01&irec=0
Headline News
March 14, 2007

The Jakarta Post, Jakarta

While Indonesia has reached the 2005 global cure rate target for tuberculosis, it still remains the most deadly communicable disease in the country, particularly in eastern regions.

A proactive approach is necessary in dealing with tuberculosis in eastern parts of Indonesia due to the often difficult geographical terrain and the lack of skilled human resources, Carmelia Basri, an official at Health Ministry responsible for tuberculosis, said Tuesday.

"We need to take an active approach for detection in this region, where the prevalence of TB is among the highest in the country. We can't just wait for patients to come to community health centers," she said on the sidelines of a symposium on tuberculosis hosted by the Coalition for a Healthy Indonesia.

Indonesia has reached the global cure target of 85 percent for TB, but a national survey found that eastern Indonesia had the highest prevalence of the disease with 210 cases for every 100,000 people, far higher than the national rate of 125. The lowest rate was recorded in Yogyakarta and Bali, with 64 cases per 100,000 people, while Java had 107 cases and Sumatra 160 for every 100,000 people.

"This year, we started a mobile health service program to detect TB cases and give proper treatment for patients. Under this program, the mobile health units will regularly visit kampongs once every three months," Carmelia said.

She said that due to a lack of financial and human resources, the program could only be implemented in turns in many regencies and municipalities in the eastern part of the country, with Papua the first target for the program.

In Papua, where the HIV infection rate is among the highest in the country, the number of co-infected people is 320 per 100,000, according to Carmelia.

Co-infection with HIV is extremely dangerous because TB is one of the leading factors in the deaths of people living with HIV. On the other hand, HIV is also the biggest risk in stimulating latent TB to become active.

The Coalition for a Healthy Indonesia said the government's efforts to combat TB, which focus on supplying free medicine, diagnostic equipment and laboratories, as well as providing training for medical personnel, allowed the country to reach the 2005 global cure rate target for the disease.

However, the detection rate only reached 68 percent, lower than the 2005 global target of 70 percent. The country recorded more than 210,000 new cases in 2004 and has estimated there will be 250,000 new cases and 300 deaths from tuberculosis annually.

Indonesia is still third in the world in terms of the TB mortality rate, after China and India.

People's lack of information about TB, its dangers and the free treatment available contributes to the high mortality rate, which is also due to the lack of political and financial support from local administrations, the coalition said.

However, the coalition, which has introduced TB communication and mobilization programs since 2005, says public understanding of the disease has improved and significantly more people are going to community health centers to be tested.

The World Medical Association Statement on HIV/AIDS and the Medical

Adopted by the WMA General Assembly, Pilanesberg, South Africa,
October 2006

Introduction

1. HIV/AIDS is a global pandemic that has created unprecedented
challenges for physicians and health infrastructures. In addition to
representing a staggering public health crisis, HIV/AIDS is also
fundamentally a human rights issue. Many factors drive the spread of
the disease, such as poverty, homelessness, illiteracy,
prostitution, human trafficking, stigma, discrimination and gender-
based inequality. Efforts to tackle the disease are constrained by
the lack of human and financial resources available in health care
systems. These social, economic, legal and human rights factors
affect not only the public health dimension of HIV/AIDS but also
individual physicians/health workers and patients, their decisions
and relationships.

Discrimination

Unfair discrimination against HIV/AIDS patients by physicians must
be eliminated completely from the practice of medicine.

1. All persons infected or affected by HIV/AIDS are entitled to
adequate prevention, support, treatment and care with compassion and
respect for human dignity.

2. A physician may not ethically refuse to treat a patient whose
condition is within his or her current realm of competence, solely
because the patient is seropositive.

3. National Medical Associations should work with governments,
patient groups and relevant national and international organizations
to ensure that national health policies clearly and explicitly
prohibit discrimination against people infected with or affected by
HIV/AIDS.


Appropriate / Competent Medical Care

1. Patients with HIV/AIDS must be provided with competent and
appropriate medical care at all stages of the disease.

2. A physician who is not able to provide the care and services
required by patients with HIV/AIDS should make an appropriate
referral to those physicians or facilities that are equipped to
provide such services. Unless or until the referral can be
accomplished, the physician must care for the patient to the
best of his or her ability.

3. Physicians and other appropriate bodies should ensure that
patients have accurate information regarding means of transmission
of HIV/AIDS and strategies to protect themselves against infection.
Proactive measures should be taken to ensure that all members of the
population, and at-risk groups in particular, are educated to this
effect.

4. With reference to those patients who are found to be
seropositive, physicians must be able to effectively counsel them
regarding: (a) responsible behaviour to prevent the spread of the
disease; (b) strategies for their own health protection; and (c) the
necessity of alerting sexual and needle-sharing contacts, past and
present, as well as other relevant contacts (such as medical
and dental personnel) regarding their possible infection.

5. Physicians must recognize that many people still believe HIV/AIDS
to be an automatic and immediate death sentence and therefore will
not seek testing. Physicians must ensure that patients have accurate
information regarding the treatment options available to them.
Patients should understand the potential of antiretroviral treatment
(ART) to improve not only their medical condition but also the
quality of their lives. Effective ART can greatly extend the period
of time that patients are able to lead healthy productive lives,
functioning socially and in the workplace and maintaining their
independence. HIV/AIDS is increasingly looked upon as a manageable
chronic condition.

6. While strongly advocating ART as the best course of action for
HIV/AIDS patients, physicians must also ensure that their patients
are fully and accurately informed about all aspects of ART,
including potential toxicity and side effects. Physicians must also
counsel patients honestly about the possibility of failure of first
line ART, and the subsequent options should failure occur. The
importance of adhering to the regimens and thereby reducing the risk
of failure should be emphasized.

7. Physicians should be aware that misinformation regarding the
negative aspects of ART has created resistance toward treatment by
patients in some areas. Where misinformation is being spread about
ART, physicians and medical associations must make it an immediate
priority to publicly challenge the source of the misinformation and
to work with the HIV/AIDS community to counteract the negative
effects of the misinformation.

8. Physicians should encourage the involvement of support networks
to assist patients in adhering to ART regimens. With the patient's
consent, counselling and training should be available to family
members to assist them in providing family based care. Physicians
must recognize families and other support networks as crucial
partners in adherence strategies and, in many places, the only means
to adequately expand the care system so that patients receive the
required attention.

9. Physicians must be aware of the discriminatory attitudes toward
HIV/AIDS that are prevalent in society and local culture. Because
physicians are the first, and sometimes the only, people who are
informed of their patients' HIV status, physicians should be able to
counsel them about their basic social and legal rights and
responsibilities or should refer them to counsellors who specialize
in the rights of persons living with HIV/AIDS.

Testing

1. Mandatory testing for HIV must be required of: donated blood and
blood fractions collected for donation or to be used in the
manufacture of blood products; organs and other tissues intended for
transplantation; and semen or ova collected for assisted reproduction
procedures.

2. Mandatory HIV testing of an individual against his or her will is
a violation of medical ethics and human rights. Exceptions to this
rule may be made only in the most extreme cases and should be
subject to review by an ethics panel or to judicial review.

3. Physicians must clearly explain the purpose of an HIV test, the
reasons it is recommended and the implications of a positive test
result. Before a test is administered, the physician should have an
action plan in place in case of a positive test result. Informed
consent must be obtained from the patient prior to testing.

4. While certain groups are labelled "high risk", anyone who has had
unprotected sex should be considered at some risk. Physicians must
become increasingly proactive about recommending testing to
patients, based on a mutual understanding of the level of risk and
the potential to benefit from testing.Pregnant women should
routinely be offered testing.

5. Counselling and voluntary anonymous testing for HIV should be
available to all persons who request it, along with adequate post-
testing support mechanisms.

Protection from HIV in the Health Care Environment

Physicians and all health care workers have the right to a safe
work environment. Especially in developing countries, the problem of
occupational exposure to HIV has contributed to high attrition rates
of the health labour force. In some cases, employees become infected
with HIV, and in other cases fear of infection causes health care
workers to leave their jobs voluntarily. Fear of infection among
health workers can also lead to refusal to treat HIV/AIDS patients.
Likewise, patients have the right to be protected to the greatest
degree possible from transmission of HIV from health professionals
and in health care institutions.

1. Proper infection control procedures and universal precautions
consistent with the most current national or international
standards, as appropriate, should be implemented in all health care
facilities. This includes procedures for the use of preventive ART
for health professionals who have been exposed to HIV.

2. If the appropriate safeguards for protecting physicians or
patients against infection are not in place, physicians and National
Medical Associations should take action to correct the situation.

3. Physicians who are infected with HIV should not engage in any
activity that creates a risk of transmission of the disease to
others. In the context of possible exposure to HIV, the activity in
which the physician wishes to engage will be the determining factor.
Whether or not an activity is acceptable should be determined by a
panel or committee of health care workers with specific expertise in
infectious diseases.

4. In the provision of medical care, if a risk of transmission of an
infectious disease from a physician to a patient exists, disclosure
of that risk to patients is not enough; patients are entitled to
expect that their physicians will not increase their exposure to the
risk of contracting an infectious disease.

5. If no risk exists, disclosure of the physician's medical condition
to his or her patients will serve no rational purpose.

Protecting Patient Privacy and Issues Related to Notification

1. Fear of stigma and discrimination is a driving force behind the
spread of HIV/AIDS. The social and economic repercussions of being
identified as infected can be devastating and can include violence,
rejection by family and community members, loss of housing and loss
of employment, to name only a few. Normalizing the presence of
HIV/AIDS in society through public education is the only way to
reduce discriminatory attitudes and practices. Until that can be
universally achieved, or a cure is developed, potentially infected
individuals will refuse testing to avoid these consequences. The
result of individuals not knowing their HIV status is not only
disastrous on a personal level in terms of not receiving
treatment, but may also lead to high rates of avoidable transmission
of the disease. Fear of unauthorized disclosure of information also
provides a disincentive to participate in HIV/AIDS research and
generally thwarts the efficacy of prevention programs.

Lack of confidence in protection of personal medical information
regarding HIV status is a threat to public health globally and a
core factor in the continued spread of HIV/AIDS. At the same time,
in certain circumstances, the right to privacy must be balanced with
the right of partners (sexual and injection drug) of persons with
HIV/AIDS to be informed of their potential infection. Failure to
inform partners not only violates their rights but also leads to the
same health problems of avoidable transmission and delay in
treatment.

2. All standard ethical principles and duties related to
confidentiality and protection of patients' health information, as
articulated in the WMA Declaration of Lisbon on the Rights of the
Patient, apply equally in the context of HIV/AIDS.

In addition, National Medical Associations and physicians should take note of the
special circumstances and obligations (outlined below)associated
with the treatment of HIV/AIDS patients.

1. National Medical Associations and physicians must, as a matter of
priority, ensure that HIV/AIDS public education, prevention and
counselling programs contain explicit information related to
protection of patient information as a matter not only of medical
ethics but of their human right to privacy.

2. Special safeguards are required when HIV/AIDS care involves a
physically dispersed care team that includes home-based service
providers, family members, counsellors, case workers or others who
require medical information to provide comprehensive care and assist
in adherence to treatment regimens. In addition to implementing
protection mechanisms regarding transfer of information, ethics
training regarding patient privacy should be given to all team
members.

3. Physicians must make all efforts to convince HIV/AIDS patients to
take action to notify all partners (sexual and/or injection drug)
about their exposure and potential infection. Physicians must be
competent to counsel patients about the options for notifying
partners.

These options should include:

1. notification of the partner(s) by the patient. In this case, the
patient should receive counselling regarding the information that
must be provided to the partner and strategies for delivering it with
sensitivity and in a manner that is easily understood. A timetable
for notification should be established and the physician should
follow-up with the patient to ensure that notification has occurred.

2. notification of the partner(s) by a third party. In this case,
the third party must make every effort to protect the identity of
the patient.

3. When all strategies to convince the patient to take such action
have been exhausted, and if the physician knows the identity of the
patient's partner(s), the physician is compelled, either by law or by
moral obligation, to take action to notify the partner(s) of their
potential infection. Depending on the system in place, the physician
will either notify directly the person at risk or report the
information to a designated authority responsible for notification.

In cases where a physician must disclose the information regarding
exposure, the physician must:

1. inform the patient of his or her intentions,
2. to the extent possible, ensure that the identity of the patient
is protected,
3. take the appropriate measures to protect the safety of the
patient,especially in the case of a female patient vulnerable to
domestic violence.
4. Regardless of whether it is the patient, the physician or a third
party who undertakes notification, the person learning of his or her
potential infection should be offered support and assistance in
order to access testing and treatment.
5. National Medical Associations should develop guidelines to assist
physicians in decision-making related to notification. These
guidelines should help physicians understand the legal requirements
and consequences of notification decisions as well as the medical,
psychological, social and ethical considerations.
6. National Medical Associations should work with governments to
ensure that physicians who carry out their ethical obligation to
notify individuals at risk, and who take precautions to protect the
identity of their patient, are afforded adequate legal protection.

Medical Education

1. National Medical Associations should assist in ensuring that there
is training and education of physicians in the most current
prevention strategies and medical treatments available for all
stages of HIV/AIDS, including prevention and support.

2. National Medical Associations should insist upon, and assist with
when possible, the education of physicians in the relevant
psychological, legal,cultural and social dimensions of HIV/AIDS.

3. National Medical Associations should fully support the efforts of
physicians wishing to concentrate their expertise in HIV/AIDS care,
even where HIV/AIDS is not recognized as an official specialty or
sub-specialty within the medical education system.

4. The WMA encourages its National Medical Associations to promote
the inclusion of designated, comprehensive courses on HIV/AIDS in
undergraduate and postgraduate medical education programs, as well as
continuing medical education.

14.10.2006

http://www.wma.net/e/policy/a25.htm

Indonesia's AIDS epidemic among the fastest growing in Asia

JAKARTA (AP): Indonesia's AIDS epidemic is among the fastest growing
in Asia, especially among intravenous drug users and commercial sex
workers, and half of new infections have been found in the
easternmost Papua province, the World Health Organization said.

"Indonesia is facing a huge threat," Bjorn Melgaard, WHO's senior
health consultant, said Saturday after an independent review team
spent nearly two weeks surveying efforts to fight theAIDS virus in
several provinces across the sprawling archipelago.

The team found that the government has put in place good strategies
and intervention programs to handle the epidemic, but more needs to
be done on a local level to secure long-term funding to fight the
spread of HIV, the virus that causes AIDS, and to improve access to
condoms, testing and counseling.

Surveillance of sexually transmitted disease also needs to be stepped
up, the team found.

There were 2,873 new AIDS cases in Indonesia in 2006, a 140 percent
increase from 1,195 in 2004, with most cases found in intravenous
drug users and commercial sex workers, the team said.

Papua, the country's most remote province geographically and
politically, had by far the largest population of people living with
the AIDS virus, accounting for 20 times the national average- around
50 percent of the country's total number of cases.

"More than 2 percent of the population in Papua were infected with
HIV/AIDS," the report said, adding that health centers in the
province must work especially hard to strengthen programs to prevent
mothers from spreading the virus to their children.

WHO warned late last year that Indonesia showed a trend that its AIDS
epidemic was still not under control, compared to neighboring
Thailand and Cambodia, where rates of infection appear to
stabilizing.

"Its HIV/AIDS epidemic is among the fastest growing in Asia,"
Melgaard said.

HIV has infected an estimated 169,000 to 216,000 in the nation of 220
million. (***)

http://www.thejakartapost.com/detailtoplatest.asp?
fileid=20070218150244&irec=0

Key Features of Chronic Dizziness Improve Diagnosis and Therapeutic Outcomes

http://www.medscape.com/viewarticle/552715
News Author: Laurie Barclay, MD
Release Date: February 26, 2007;

February 26, 2007 — Key clinical features of chronic dizziness may improve diagnosis and therapeutic outcomes, according to the results of a prospective cohort study reported in the February issue of the Archives of Otolaryngology, Head & Neck Surgery.

"The relationships among [chronic subjective dizziness (CSD)], anxiety disorders, neurotologic conditions, and other medical causes of chronic dizziness are not fully understood," write Jeffrey P. Staab, MD, MS, and Michael J. Ruckenstein, MD, of the University of Pennsylvania Health System in Philadelphia, and colleagues. "The current investigation sought to clarify the prevalence and comorbidity of medical and psychiatric causes of chronic dizziness."

From 1998 to 2004 at a tertiary care balance center, 345 men and women, aged 15 to 89 years, were referred for evaluation of chronic dizziness (duration of ≥ 3 months) of uncertain cause. These patients were systematically directed through multiple specialty examinations until definitive diagnoses were reached.

Nearly all patients with CSD were diagnosed with psychiatric or neurologic illnesses, including primary and secondary anxiety disorders (n = 206; 59.7%) and central nervous system conditions (n = 133; 38.6%). The latter group included migraine headaches, mild traumatic brain injuries, and neurally mediated dysautonomias. Six patients (1.7%) had dysrhythmias, and 4 of 5 patients with migraine or dysrhythmias had comorbid anxiety.

"Chronic dizziness has several common causes, including anxiety disorders, migraine, traumatic brain injuries, and dysautonomia, that require different treatments," the authors write. "Key features of the clinical history distinguish these illnesses from one another and from active neurotologic conditions. The high prevalence of secondary anxiety may give a false impression of psychogenicity."

Of the 6 patients with dysrhythmias, all had psychiatric disorders. The most significant dysrhythmias were atrial fibrillation and Wolfe-Parkinson-White syndrome.

"This study demonstrated the clinical usefulness of CSD as a diagnostic concept to identify patients with persistent dizziness sustained by nonotologic mechanisms," the authors conclude. "High levels of coexisting anxiety frequently dominated the clinical picture and confounded recognition of associated medical illnesses. Key diagnostic features were identified in the clinical history for each illness. Careful inquiry about these key features during otologic evaluations may increase diagnostic precision and lead to more specific treatment recommendations for these perplexing patients."

This study was not supported by commercial funding, and the authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2007;133:170-176.

Building blocks of democracy

http://www.thejakartapost.com/detaileditorial.asp?fileid=20070227.E01
Editorial
February 27, 2007

Chief economics minister Boediono's observation over the weekend about the linkage between the per capita income level and the sustainability of democracy is not a choice between India's democracy and China's authoritarian path, nor an issue of development first, democracy later.

Rather, the essence of his speech Saturday during his inauguration as professor of economics at Gadjah Mada University in Yogyakarta was a strong warning that without significant improvement in the living conditions of the people, the democratic process in the country will not be sustainable.

With decades of experience in political and economic issues, Boediono is highly competent in analyzing the links between poverty and the sustainability of democracy. He supported the conclusions of several economic studies that the country should reach some sort of middle-income threshold to be able to sustain democracy, citing a per capita income of more than US$6,000 on a purchasing power parity basis (PPP), as a strong foundation.

Since Indonesia's per capita income is still $4,000 on a PPP basis, the democratic process in the country could be highly vulnerable to political and social instability.

How does poverty threaten representative government in Indonesia, the world's third-largest democracy?

Democracy means little to the 40 million unemployed and underemployed people, and the 110 million who live on less than $2 a day. It means little to poor people such as unemployed university graduates who have nothing to lose. They are instead ripe for being exploited by radicals for causes they think would dramatically change the condition for their own good.

Mass poverty, income inequities are fertile soils for radical groups, whether religious- or secular-based ones. Democracy therefore must be supported by a broad-based social-economic development to make the process sustainable.

Chronic, absolute poverty, which increased last year by almost 11 percent, means an increasing number of people have become increasingly impatient about what they think as the failure of democracy to deliver better living conditions.

Economic hardships could play into the hands of religious and political extremists, as disillusioned people get more and more desperate, and radical ideas and solutions they used to reject sound more acceptable. Poverty and unemployment make people frustrated and make them highly vulnerable to being manipulated by extremists or radicals eager to organize the people's anger into a force that can sabotage the democratic system.

Hence, productive employment is key to reducing threats to democracy, because as long as people are content, there will not be the kind of dissatisfaction that can breed violence or militant extremists. If young people have work then they are busy and less likely to fall in with extremist groups.

Boediono's message warns that the failure to cope with poverty and unemployment could strengthen radical movements in Indonesia, thereby threatening its nine-year-old democracy and the path toward a market-based economy. Worsening living conditions also could foil military reform, which is a central component of the democratic process.

However, as Boediono also asserted, democracy is only one of the prerequisites for equitable economic development. The rule of law is another key factor, especially in a country such as Indonesia, which is still in a transition from three decades of authoritarian rule into a nascent democracy. The fact that the masses are accustomed to following authority has thus far left room for politicians to escape accountability.

The chief economic minister's observation should prompt the government to focus on equitable growth, the kind that generates a lot of jobs, because inequitable income distribution also threatens democracy.

The government has acknowledged that the quality of growth over the past five years has declined, in that one unit of growth produced a smaller number of jobs because investors tried to avoid labor-intensive businesses, citing the high costs of what they see as overly rigid labor regulations.

If this trend continues it will require an annual economic growth of more than 7 percent to absorb the unemployed and new job seekers entering the labor market annually. This is rather a bleak outlook because the economy grew only 5.5 percent last year, down slightly from 5.6 percent in 2005. It is projected to expand by only 6.3 percent this year. Even that target has been seen by most analysts as too optimistic, due to the slower-than-expected pace of economic reforms.

The strongest message of Boediono's observation about the link between per capita income and democracy is for the government to demonstrate stronger leadership in speeding up reforms, not only in the economy but also in basic infrastructure and public administration.

House backs 'de-radicalization'

http://www.thejakartapost.com/detailheadlines.asp?fileid=20070227.@01&irec=0
Headline News
February 27, 2007

Ridwan Max Sijabat, The Jakarta Post, Jakarta

The House of Representatives on Monday threw its weight behind a government "de-radicalization campaign" aimed at stopping the establishment of hard-line religious groups and countering terrorism.

In a hearing with Coordinating Minister for Political, Legal and Security Affairs Widodo A.S. here, members of the House's defense, political and foreign affairs commission also said the government should make a concerted effort to deal with poverty, unemployment and underdevelopment, which they said contributed to terrorism and violence in the name of religion.

Also attending the hearing were Home Minister M. Ma'ruf, Defense Minister Juwono Sudarsono, Maritime Affairs and Fisheries Minister Freddy Numberi, Indonesian Military Commander Air Chief Marshall Djoko Suyanto, National Police chief Gen. Sutanto and National Intelligence Agency head Syamsir Siregar.

"De-radicalization is urgently needed to improve the people's awareness of terrorism and ensure an understanding of religion and their teachings. The problem is not religions themselves but some of the people who claim to be adherents. Such a move will help the government win full support from the people to counter terrorism," the chairman of the House commission, Theo Sambuaga, said at the conclusion of the rare meeting with the ministers and security authorities.

During the hearing, the commission questioned what it called the "repressive approach" employed by the police in the pursuit of 29 wanted radicals in Poso, Central Sulawesi. It also asked about the progress in the hunt for fugitive Malaysian bombmaker Noordin M. Top, the prosecution of terrorist suspects and the possible execution of five terrorists sentenced to death for their involvement in the 2002 Bali bombings.

Many legislators also expressed their concern over a recent rise in air and sea accidents, and questioned whether it was possible terrorist attacks were behind any of the accidents. They said many people were now afraid to take planes, ferries or trains.

"From a recent tour of several provinces, we found many people have suspicions that terrorism is behind the increasing number of sea and air accidents. We got the impression that the government is seen as less than professional in managing the transportation sector and investigating accidents," Andreas Parera of the Indonesian Democratic Party of Struggle (PDI-P) said.

Other legislators asked the government to take concrete measures to lift more people out of poverty and give them jobs, saying the poor and disenfranchised were more at risk of being exploited by terrorists. They pointed out that most of the young people recruited by Noordin M. Top and slain terrorist mastermind Azahari were from poor families.

"Poverty, unemployment, underdevelopment, injustice and the skyrocketing prices of basic commodities are real threats to our internal security," Happy Bone Zulkarnain of the Golkar Party said.

The antiterror desk chief at the Coordinating Ministry for Political, Legal and Security Affairs, Ansyaad Mbai, said the government has enhanced cooperation with religious leaders, clerics and communal leaders to prevent the misuse of religious teaching to justify terrorist attacks.

He said the government has won support for the campaign from the two largest Muslim organizations in the country, Nahdlatul Ulama and Muhammadiyah.

Meanwhile, National Police chief Gen. Sutanto defended the police's handling of terrorist suspects, including the wanted radicals in Poso. He said the police had procedures in place to ensure the protection of human rights.

Outgoing WB rep in Jakarta says alternatives to CGI would be useful

http://www.thejakartapost.com/yesterdaydetail.asp?fileid=20070224.L01

Business and Investment - February 24, 2007

The Jakarta Post, Jakarta

While supporting the winding up of the Consultative Group on Indonesia (CGI), outgoing World Bank country director Andrew Steer said dialog and discussions with the international donor community will continue to be useful for the nation's development programs.

"I think it would be a pity if there is not some kind of a forum to discuss important issues. I mean, Indonesia does need to think about how to bring in trade, investment, ideas and technology," he said Friday on the sidelines of a farewell meeting with The Jakarta Post.

"It would be useful if it is replaced by something, not necessarily one big forum. It could be thematic forums on infrastructure, on education, on health," he explained.

He said that while ministers had made it very clear that dialog will continue, "down below in the bureaucracy, there is a bit of confusion."

The government has said it has no plans to set up any kind of formal or regular forum as a substitute for the CGI, though it has stressed that it will continue to engage in dialog with international lenders and donors.

"No, we consider it unnecessary to establish another forum. But we may hold informal discussion forums, like seminars," said Mahendra Siregar, the deputy for international economic cooperation at the Coordinating Ministry for the Economy, during a discussion Tuesday on the future of Indonesian government financing after the CGI.

In farewell remarks on Indonesia, Steer said he was optimistic about the nation's economy, saying it was on the right track to fully recover from the 1997 Asian financial crisis.

"When I first came here about 4.5 years ago, the No. 1 item on the budget was interest (payments on foreign debts)," he said. "Indonesia had to allocate more than 25 percent of the budget to pay interest. Now, it only allocates 10 percent," he said.

Steer also praised Indonesia's achievements in reducing the debt-to-GDP ratio from 100 percent in 1999 to the current figure of 38 percent.

"It is also a remarkable fact that Indonesia has now launched what may be the biggest educational reform in the world," he said, adding that the government had doubled spending on education over the last few years. "If it goes ahead, it could have a remarkable impact."

However, Steer said Indonesia must be able to speed up the building of roads, rail links, ports and power plants to attract investment and boost growth. "It would actually be very interesting to know why education spending has rapidly increased whereas infrastructure spending has not," he said.